Thèse d'exercice : Médecine : Nancy 1 : 2003. / Titre provenant de l'écran-titre.

Characteristically, in infections that are caused by the zoonotic pathogen Bartonella naturally infected reservoir hosts are asymptomatic, where infected incidental, non-natural, hosts develop symptomatic disease. Cat-scratch disease (CSD) is a well known example. Bartonella infections in humans may be self-limiting or fulminant and affect different organ systems. The objectives of the present thesis were to (1) identify and characterise Bartonella infection cases in Sweden, (2) to investigate certain human populations regarding Bartonella infections, and (3) compare natural populations of different Bartonella species. Cases with typical and atypical CSD were recognised by using a combination of PCR and serology. Gene sequence comparisons of different genes in B. henselae isolates from the United States and Europe showed that ftsZ gene variation is a useful tool for Bartonella genotyping. Myocarditis was a common finding among Swedish elite orienteers succumbing to sudden unexpected cardiac death (SUCD). The natural cycle of Bartonella spp., the life style of orienteers, elevated antibody titres to Bartonella antigens, Bartonella DNA amplified from myocardium and the lack of another feasible explanation make Bartonella a plausible aetiological factor. The first reported case of Bartonella endocarditis (B. quintana) was identified in an immunocompromised patient who underwent heart valve replacement. The patient had been body louse-infested during his childhood. It is hypothesised that a chronic B. quintana infection was activated by the immunosuppression. There was no evidence of an ongoing trench fever (TF) epidemic in a Swedish homeless population, although an increased risk for exposure to Bartonella antigens was demonstrated. The lack of louse infestation might explain the absence of B. quintana bacteremia and low B. quintana antibody titres. Comparisons of genetic loci and the whole genomes of environmental B. grahamii isolates from the Uppsala region, Sweden displayed variants that were not related to specific host species but to geographic locality. Natural boundaries seemed to restrict gene flow.

Made available in DSpace on 2015-10-23T12:47:04Z (GMT). No. of bitstreams: 2 ana_silva_ioc_mest_2014.pdf: 1478235 bytes, checksum: 6d52627a1a269a7288d87d75c2559e6c (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2015-04-14 / Fundação Oswaldo Cruz, Instituto Oswaldo Cruz, Rio de Janeiro, RJ, / O aumento do consumo de drogas ilícitas na atualidade vem acompanhado não apenas do impacto social e econômico, como também na saúde. As pessoas que injetam drogas apresentam maior susceptibilidade a infecções por diversos agentes, devido ao uso da droga e à subsequente imunossupressão, como também pelo risco de maior exposição a agentes transmitidos por artrópodes e reservatórios vertebrados em ambientes insalubres. São muitos os estudos correlacionando o consumo de drogas à infecção pelo HIV, VHB e VHC, porém raros investigam outros agentes. No presente estudo transversal e retrospectivo, selecionamos aleatoriamente 300 amostras de um estudo multicêntrico da década de 1990 e fizemos a pesquisa sorológica para Bartonella spp., Coxiella burnetii e Hantavirus. O perfil demográfico e social encontrado mostrou-se em concordância com a literatura: homens, jovens, de baixa renda e com histórico de prisão. A maior parte apresentava situações de risco por injetar drogas com dispositivos previamente usados e por injetar em local público. Alguns fatores foram discordantes da literatura internacional e podem ter influenciado os resultados, uma vez que são considerados situações de risco, como escassez de pessoas que injetaram drogas enquanto presas, que residem em instituições, ou sem-teto A evidência de infecção por C. burnetii foi de 9,3%, praticamente o dobro da observada na população geral brasileira, embora, em comparação com dados internacionais, a prevalência tenha sido menor. Não houve diferença estatística significativa em relação às variáveis demográficas entre os grupos sororeativos e soronegativos para febre Q. A presença de anticorpos anti-Bartonella foi de 1%, bem discrepante dos estudos nacionais e internacionais. Pode ser justificado pela não inclusão no teste sorológico de antígeno de B. elizabethae e de B. quintana e pela reduzida frequência de sem-tetos. Não houve correlação do alto consumo de álcool com maior soroprevalência por Bartonella spp., provavelmente pelos motivos acima citados. A soroprevalência para hantavirose de 4% foi semelhante à descrita em estudo brasileiro na população geral. Em relação aos usuários de drogas injetáveis, somente um artigo americano evidenciou uma soroprevalência bem menor, de 0,2%. Isso indica que em meios urbanos brasileiros, hantavírus, provavelmente o Seoul, pode estar circulando. Embora considerando que o estudo foi retrospectivo com base em evidência sorológica e que a possibilidade de reação cruzada não pode ser totalmente descartada, o presente estudo aponta para a importância de se incluir a pesquisa de outros agentes infecciosos além do HIV e dos vírus das hepatites B e C na população injetora de drogas / The increased consumption of illicit drugs today is followed not only by a social and economic impact, as well as in health. People who inject drugs are more susceptible to infections by various agents due to drug use and subsequent immunosuppressi on, as well as the risk of increased exposure to agents transmitted by arthropods and vertebrate reservoirs in unhealthy environments. Many studies link drug use to HIV, HBV and HCV, however only a few investigate other agents. In this re trospective cross - sectional study, we selected randomly 300 samples from a multicenter study from the 1990s and made a serological survey for Bartonella spp., Coxiella burnetii and hantavirus. The demographic and social profile was found in agreement with the literature: me n, young age , low income and with a history of imprisonment . The majority was exposed to risk situations by injecting drugs with previously used devices and by injecting in a public place s . Some factors were dis agreeing with the international literature an d may have influenced the results, since they are considered high - risk situations, such as shortage of people who injected drugs while imprisoned, residing in institutions, or homeless. Evidence of C. burnetii infection was 9.3%, almost double the rate in the general Brazilian population, although in comparison with international data, the prevalence was lower. There was no statistically significant difference in relation to demographic variables among seroreactive and seronegative groups for fever Q. The p resence of antibodies to Bartonella was 1%, significantly discrepant from national/ international studies. Possibly justified by the non inclusion of antigen B. elizabethae and B. quintana in the serological test , and the reduced frequency of homelessness. There was no correlation between high alcohol consumption with higher seroprevalence of Bartonella spp., p robably for the reasons mentioned above. The seroprevalence of hantavirus 4% was similar to that described in a Brazilian study in the general populat ion. Regarding inje c t ing drug users , only an American paper showed a much lower prevalence of 0.2%. This indicates that in Brazilian urban areas, hanta virus can circulate , probably Seoul hantavirus . While considering that the study was retrospective based on serological evidence and the possibility of cross - reactivity cannot be completely ruled out, this study points to the importance of including the research of other infectious agents other than H IV and hepatitis viruses B and C in injectin g drug population

Determina el porcentaje de Lutzomyias naturalmente infectadas con Bartonella bacilliformis usando la técnica de PCR en tiempo real. Esta prueba es desarrollada en un trabajo anterior para poder detectar cantidades tan pequeñas como 100fg de ADN de Bartonella en Lutzomyias. Se utiliza el protocolo anterior usando primers del gen del citrato sintetasa como blanco. En este estudio se estandariza la prueba en un equipo de tiempo real diferente y se refina el protocolo para obtener mejores resultados. Se procesan muestras de la zona epidémica de Cusco, zona donde se encuentra distribuida la especie Lutzomyia peruensis. Se usa las Lutzomyia peruensis hembras sin alimentar en grupos de cinco (pool) para extraer el ADN. Los resultados obtenidos de las 627 muestras procesadas, 45 muestras son positivas que equivale a un rango de infección de 7.18%. La sensibilidad de la prueba es 100% y especificidad es de 95.50% basada en las pruebas usando muestras controles. / Tesis

Demodex est un genre d’acariens dont deux espèces sont connues pour coloniser la peau de l’homme : Demodex folliculorum et Demodex brevis. Leur implication dans le développement de la rosacée reste controversée. Cette maladie est caractérisée par une inflammation chronique de la peau et est définie en quatre sous-type majeurs : la rosacée érythémato-télangiectasique (ETR), la rosacée papulopustuleuse (PPR), la rosacée phymateuse et la rosacée oculaire. Certains pensent que le rôle des acariens est principalement d’exacerber une inflammation déjà enclenchée. Toutefois, l’isolation par culture d’un Bacillus oleronius à partir du broyat d’un Demodex de patient atteint de rosacée papulopustuleuse ont remis sur le devant de la scène le rôle de l’acarien en tant que vecteur de bactéries pathogènes. Le but de notre étude était de décrire le microbiote associé au Demodex par clonage du gène de l’ARN ribosomal 16S afin d’identifier par la suite d’éventuelles différences en fonction du statut de l’hôte (ETR, PPR ou sain). Le microbiote décrit présentait une diversité jusqu’alors insoupçonnée. Une partie des espèces identifiées n’avaient jamais été rapportées chez l’homme, pouvant donc correspondre au microbiote spécifique de l’acarien. Il serait composé comme d’une majorité de Protéobactéries. De manière intéressante, les proportions des phyla majeurs étaient différentes en fonction du groupe étudié. De plus, il semblerait que certaines espèces soient spécifiques des Demodex collectés chez des patients atteints de rosacée. Par exemple, Bartonella quintana n’a été détectée qu’à partir de Demodex d’une patiente atteinte de rosacée érythémato-télangiectasique. / Demodex is a genus of mites comprising two species known to colonize human skin: Demodex folliculorum and Demodex brevis. Their role in the pathogenesis of rosacea remains controversial. Rosacea is defined by a chronic inflammation of the skin and four main subtypes are defined : erythematotelangiectasic rosacea (ETR), papulopustular rosacea (PPR), phymatous rosacea and ocular rosacea. Mites are thought to be only involved in the exacerbation of a pre-existing inflammation. The growth of Bacillus oleronius from a crushed Demodex mite collected on a PPR patient gave rise to a new hypothesis that the mite is actually the vector of pathogenic bacteria. Present study aimed at describing the microbiote associated with Demodex mites by a 16S rRNA clone library approach. This allowed us to compare the obtained bacterial communities according to the group of patients the mites were collected from (erythematotelangiectasic rosacea, papulopustular rosacea or healthy subjects). The microbiota described here revealed an unexpected diversity. Part of the identified species had never been reported on human beings and could thus represent the microbiota specific to Demodex. As in many arthropods, this microbiota was predominantly composed of Proteobacteria. Interestingly, the proportion of the main phyla Proteobacteria, Firmicutes and Actinobacteria differed according to the host status. Though, some species appeared to be specific to Demodex collected from patients with erythematotelangiectasic rosacea or papulopustular rosacea. Among them, we identified Bartonella quintana only from a mite collected on a patient with erythematotelangiectasic rosacea.

Notre objectif est d’évaluer la sérologie, la biologie moléculaire et la culture pour le diagnostic des infections liées aux bactéries intracellulaires.La sérologie occupe une place importante dans le dépistage, le suivi et le monitoring des patients présentant une infection cardiovasculaire à C. burnetii ou Bartonella. Cependant, nous avons montré quelques limites aux seuils précédemment établis pour le diagnostic d’endocardite. Ce travail suggère que les faibles titres d’anticorps n'excluent pas le diagnostic de l'infection cardiovasculaire chez les patients ayant des facteurs prédisposant et qu'une valeur de seuil sérologique ne peut fournir une VPP de 100%.La qPCR réalisée sur des prélèvements cardiovasculaires pour le diagnostic d’endocardite à C. burnetii et Bartonella est plus sensible que la culture et l’immunohistochimie. Toutefois, des qPCR négatives ont été obtenues chez des patients présentant une endocardite avec de fort titre d’anticorps, par conséquent une qPCR négative ne doit pas définitivement exclure le diagnostic. Nous avons montré que l’ADN est capable de persister dans les prélèvements, malgré un traitement antibiotique préalable. Nous avons alors développé un nouvel outil pour évaluer la viabilité bactérienne en quantifiant la transcription de l'ARNr 16S de C. burnetii.La culture des bactéries intracellulaires reste nécessaire pour permettre la caractérisation des bactéries et faciliter le développement d'outils diagnostiques. Au cours de cette thèse, nous avons mis au point une technique innovante de plage de lyse pour mettre en évidence un effet délétère des antibiotiques sur les cellules infectées par R. conorii. / The aim of our study is to evaluate serology, molecular biology and culture for the diagnosis of intracellular bacteria.Serology plays an important role in the detection of Q fever and Bartonella infections and for the follow up and monitoring of patients with cardiovascular infection. However, we have shown some limits to the use of serological thresholds previously established for the diagnosis of endocarditis. In 2 series of Q fever and Bartonella endocarditis, we diagnosed patients with a definite cardiovascular infection associated with low antibody levels (<800). This work suggests that low antibody titers do not exclude the diagnosis of cardiovascular infection in patients with predisposing factors and a value of serological threshold cannot provide a positive predictive value of 100%.qPCR performed on cardiovascular samples for the diagnosis of C. burnetii and Bartonella endocarditis is more sensitive than the amplification of the 16S rRNA gene, culture and immunohistochemistry. Nevertheless, negative qPCR were obtained for patients presenting endocarditis with high antibody titer, therefore a negative qPCR should not definitively exclude the diagnosis. On the other hand, we have shown that DNA can persist in clinical specimens, despite previous antibiotic treatment. We developed a new tool to assess bacterial viability by quantifying the transcription of the 16S rRNA of C. burnetii.Culture of intracellular bacteria is necessary to enable the characterization of bacteria and facilitate the development of diagnostic tools. We developed an innovative technique of plaque assay to highlight a deleterious effect of antibiotics on infected cells by R. conorii.

Submitted by JÚLIO HEBER SILVA (julioheber@yahoo.com.br) on 2017-05-26T19:06:37Z No. of bitstreams: 2 Tese - Eduardo Sugizaki - 2011.pdf: 1614665 bytes, checksum: c1512eaa0135859f4c7c6fa48dfb2d02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-05-30T10:20:42Z (GMT) No. of bitstreams: 2 Tese - Eduardo Sugizaki - 2011.pdf: 1614665 bytes, checksum: c1512eaa0135859f4c7c6fa48dfb2d02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-05-30T10:20:42Z (GMT). No. of bitstreams: 2 Tese - Eduardo Sugizaki - 2011.pdf: 1614665 bytes, checksum: c1512eaa0135859f4c7c6fa48dfb2d02 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2011-12-05 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This doctoral thesis is a historical and epistemological research of the clinical age of Carrion's disease (1842-1885) and of the early age of his bacteriologic study (1885-1913). That´s a disease born within a historical narrative about the medical effects of experimental inoculation that the medical student Daniel Alcides Carrión, was made to do in August 1885. According to the peruvian historical narrative about the origins and consequences of the medical experiment, the student was inoculated with the blood of a disease known as Peruvian wart, but developed and died, in October five, from the disease called Oroya fever. The experiment would then have shown that there are not two diseases, but only one, that which, since then, bears his name as a tribute to the heroic gesture of inoculation. According to current knowledge about the disease, it has two stages in its evolution or syndromes. A febrile phase, anemiante, acute and of high risk for the patient's life; another phase, which follows the first, is the development of a characteristic skin neoformation, with the form of papules blood, called Peruvian wart. The historiography of the disease, after 1940, suggests that this duality of pathological manifestation represented the clinical difficulty explaining the genesis and outcome of the experiment of Carrion. However, research of documents relevant to the experiment of 1885, made in the first chapter of our thesis, showed that the experiment was not aimed at overcoming the dichotomy of two diseases. The student already had an advanced understanding of the overall clinical progression of the disease, including its two stages. From our investigation, moreover, we conclude that the peruvian medicine considered demonstrated that the inoculation produced Oroya fever, but the peruvian medicine does not present anywhere the ways in which one can recognize the Oroya fever. Due to these problems was undertaken in the second chapter, the study of the period of foundation of Peruvian wart clinic (1842-1872) and came to the conclusion that at this time there already was a complete understanding of the evolution of disease, including its stages and forms of development. At this point in our investigation, the existence of the notion of Oroya fever has appeared as unnecessary for the clinical knowledge of the disease. Therefore, the third chapter of our thesis investigated the period from 1872 to 1885, a time when the notion of Oroya fever appears in medical literature. Our investigation has shown that the notion appeared in Peruvian medicine because it regarded the disease as being a strictly benign, afebrile rash. Consequently, the Peruvian nosological dualism appears as a result of its inability to explain the phenomena of the general economy’s commitment that anticipate the eruption of Peruvian wart. With this new understanding of the clinical description of disease, we retake, in the fourth chapter, what happened in the study of disease, after the experiment of Carrión. A review of medical literature of the period between 1885 and 1898 showed that the historical narrative of Lima on the 7 experiment of Carrion became a guiding discipline of all research on the disease of this new period. During one stage of that Peruvian research (1885-1898), required to remain still only clinic, the study of disease was a prisoner of its assumptions - it became necessary, to keep the interpretation of the experiment as true, to define the concept of Oroya fever. But the final solution was not reached because the effort of maintaining doctrinal assumptions was placed above the results of observation. This closed circle began to be broken with the discovery of Tamayo, in 1905, that part of what physicians called Oroya fever was the result of a very common complication of severe cases of Peruvian wart with paratyphoid bacilli. The fourth chapter is concerned, yet, to the period after the discovery of Tamayo, from 1905 to 1913, to know the fate of Oroya fever. This research shows that the Peruvian medicine did not give up of the traditional historical narrative about the Carrion’s experiment. After Tamayo’s explanation of the reasons of part of what is called Oroya fever, the Peruvian medicine refused to give up of the use of this notion. Arce, the main Peruvian defender of the traditional historical narration about the disease, in 1913, meaning to seek the recovery of significance of Oroya fever that kept alive the dual polarity needed to remain true to the idea that, in 1885, has been demonstrated the unity between the two diseases. This doctoral thesis has obtained, thus, the construction of a new history of knowledge of Carrion’s disease, for the period 1842 to 1913. / Esta tese doutoral é uma investigação histórica e epistemológica da idade clínica da doença de Carrión (1842-1885) ao início da idade bacteriológica de seu estudo (1885-1913). Trata-se de uma doença nascida no interior de uma narrativa histórica médica sobre os efeitos da inoculação experimental que o estudante de medicina Daniel Alcides Carrión, se fez fazer em agosto de 1885. Segundo a narrativa médica limenha sobre o experimento, suas origens e suas consequências, o estudante inoculara-se com o sangue de uma doença conhecida como verruga peruana, mas desenvolveu e morreu, em cinco de outubro daquele mesmo ano, da doença chamada febre de Oroya. O experimento teria, assim, demonstrado que não há duas doenças, mas uma só que, desde então, leva seu nome, como homenagem ao gesto heroico da inoculação. Segundo o conhecimento atual sobre a doença, ela possui duas fases ou síndromes em sua evolução. Uma febril, anemiante, aguda e de alto risco para a vida do doente. Outra, que sucede a primeira, é o desenvolvimento de uma neoformação cutânea característica, com a forma de pápulas sanguíneas, chamada verruga peruana. A historiografia sobre a doença, posterior a 1940, sugere de que esta dualidade de manifestação patológica representou a dificuldade clínica que explica a gênese e o resultado do experimento de Carrión. Entretanto, a investigação dos documentos pertinentes ao experimento de 1885, feita no primeiro capítulo de nossa tese, mostrou que o experimento não visava a ultrapassar a dicotomia de duas doenças. O estudante já detinha uma compreensão clínica global avançada da evolução da doença, incluindo as suas duas etapas. Da nossa investigação, ademais, resultou que a medicina limenha deu por demonstrado que a inoculação produziu a febre de Oroya, mas ela não apresentou, em lugar algum, os modos pelos quais se pode reconhecer a febre de Oroya. Em função destes problemas, empreendeu-se, no capítulo segundo, o estudo do período de fundação da clínica da verruga peruana (1842 a 1872) e chegou-se à conclusão de que, nesta época, já havia uma compreensão global da evolução completa da doença, incluindo as suas etapas e formas de desenvolvimento. A esta altura da nossa investigação, a existência da noção de febre de Oroya já aparecia como desnecessária para o conhecimento clínico da doença. Por isso, o capítulo terceiro de nossa tese investigou o período de 1872 a 1885, época em que a noção de febre de Oroya aparece na literatura médica. Nossa investigação mostrou que a noção surgiu na medicina limenha porque esta concebia a doença como sendo estritamente uma erupção cutânea, apirética e benigna. Consequentemente, o dualismo nosológico peruano aparece como resultado da sua incapacidade de explicar os fenômenos de comprometimento geral da economia que antecipam a erupção da verruga peruana. Com essa nova compreensão da descrição clínica da doença, retoma-se, no quarto capítulo, o que aconteceu, no estudo da doença, depois do experimento de Carrión. A análise da literatura médica do período de 1885 a 1898, aí realizada, mostrou que a narrativa 5 histórica limenha sobre o experimento de Carrión tornou-se uma disciplina ordenadora de toda pesquisa sobre a doença deste novo período. Durante uma etapa da pesquisa (1885-1898), obrigada a ainda permanecer apenas clínica, o estudo da doença esteve prisioneiro de seus pressupostos. Tornou-se necessário, para manter como verdadeira a interpretação do experimento, definir o conceito de febre de Oroya. Mas não se chegava à solução definitiva porque o esforço de manutenção dos pressupostos doutrinários era colocado acima dos resultados da observação. Este círculo fechado começou a ser quebrado com a descoberta de Tamayo, em 1905, de que parte daquilo que os clínicos chamavam de febre de Oroya era resultado de uma complicação muito frequente dos casos graves de verruga peruana por bacilos paratifoides. O capítulo quarto ocupa-se, ainda, do período posterior à descoberta de Tamayo, de 1905 a 1913, para conhecer o destino da febre de Oroya. Desta investigação resulta que a medicina peruana não abriu mão da narrativa histórica tradicional do experimento de Carrión. Depois que Tamayo deu a explicação das razões de parte daquilo a que se chamara de febre de Oroya, a medicina peruana não aceitou desistir do uso desta noção. Arce, o principal defensor da narração histórica tradicional sobre a doença, em 1913, procurou recuperar uma significação para a febre de Oroya que mantivesse viva a polaridade dualista necessária para que permanecesse verdadeira a ideia de que, em 1885, foi demonstrada a unidade entre duas doenças. A presente tese doutoral obteve, assim, a construção de uma nova história do conhecimento da doença de Carrión, relativa ao período de 1842 a 1913.

Memoria para optar al Título Profesional de Médico Veterinario / Con el propósito de conocer si existe asociación entre la presentación de gingivitis con la seropositividad a Bartonella henselae en felinos domésticos, se analizaron 144 gatos en la ciudad de Santiago, provenientes de los Hospitales Clínicos Veterinarios de la Universidad de Chile, de ambos sexos, mayores de un año, negativos a las pruebas de Inmunodeficiencia Viral Felina y Leucemia Viral Felina. Todos los gatos fueron clasificados, según la presencia o ausencia de gingivitis, en dos grupos de 72 gatos cada uno. Para la determinación clínica de gingivitis se utilizó una adaptación del índice descrito por Loe y Silness. Para el diagnóstico serológico de Bartonella henselae se utilizó una prueba comercial de inmunofluorescencia indirecta (SLIDE ®). De los todos gatos analizados, el 73,6% fue seropositivo a Bartonella henselae y de los 72 gatos con gingivitis, el 87,5% de ellos fueron seropositivos. Mediante la prueba de Chi cuadrado, se determinó que no hay independencia entre la presentación de gingivitis y la seropositividad a Bartonella henselae (p<0,05)

Antecedentes: El síndrome febril agudo representa un importante desafío para la salud en la población de la Amazonía peruana, debido a sus diversas etiologías y la falta de disponibilidad de métodos diagnósticos específicos. En Perú, Madre de Dios es una de las regiones más endémicas del dengue y la leptospirosis, así como de otros agentes etiológicos bacterianos emergentes, como la bartonelosis y la rickettsiosis, cuya prevalencia generalmente no se reporta. Objetivo: Identificar molecularmente la presencia de Bartonella bacilliformis, Leptospira spp. y Rickettsia spp. en muestras de suero de pacientes con síndrome febril de Madre de Dios, Perú. Metodología: Se analizaron 139 muestras de suero de pacientes con síndrome febril mediante RT-PCR para detectar la presencia de Bartonella bacilliformis, Leptospira spp. y Rickettsia spp. Resultados: Bartonella bacilliformis fue la bacteria más prevalente identificada en el 21,6% (30/139) de las muestras, seguida de Leptospira spp. en 11.5% (16/139) y Rickettsia spp. en el 6,5% (9/139). Los síntomas más frecuentes asociados con fiebre fueron cefaleas, mialgias y artralgias. Conclusiones: En este estudio B. bacilliformis (21.6%), Leptospira spp. (11.5%) y Rickettsia spp. (6.5%) fueron las bacterias más frecuentes. Superior al 29.5% de muestras con etiología viral de Chikungunya y Oropouche, como los más frecuentes, obtenidos en un estudio previo. Este estudio confirma que la falta de especificidad de los signos y síntomas no solo se asocia con infecciones arbovirales, sino también con la presentación clínica de infecciones bacterianas endémicas. Es crucial implementar herramientas de diagnóstico más sensibles y específicas en los programas nacionales de vigilancia. / Background: Acute febrile illness (AFI) represent a significant health challenge in the population of the Peruvian Amazon, due to their diverse etiologies and the unavailability of specific on-site diagnostic methods. In Peru, Madre de Dios is one of the most endemic regions to dengue and leptospirosis, as well as other emergent bacterial etiologic agents of AFI, such as bartonellosis and rickettsiosis, whose prevalence is not usually reported. Aim: Identify molecularly the presence of Leptospira spp., Bartonella bacilliformis, and Rickettsia spp. in serum samples from patients with AFI from Madre de Dios in Peru. Methods: 139 Serum samples from patients with acute febrile illness were analyzed by RT-PCR for detecting the presence of Bartonella bacilliformis, Leptospira spp. and Rickettsia spp. Results: Bartonella bacilliformis was the most prevalent bacteria identified in 21.6% (30/139) of the samples, followed by Leptospira spp.in 11.5% (16/139) and Rickettsia spp.in 6.5% (9/139). The most frequent symptoms associated with fever among all groups, were headaches, myalgias, and arthralgias. Conclusions: In this study B. bacilliformis (21.6%), Leptospira spp. (11.5%) and Rickettsia spp. (6.5%) were the most common bacteria. Superior to 29.5% of samples with viral etiology, with Chikungunya and Oropouche as the most frequent, obtained in a previous study. This study confirms that the un-specificity of signs and symptoms is not only associated with arboviral infections, but also with the clinical presentation of endemic bacterial infections. It is crucial to implement more sensitive and specific diagnostic tools in national surveillance programs. / Tesis

Cat scratch's disease caused by Bartonella henselae, is known to be a self-limited benign process in immunocompetent children. The association with neurologic manifestations is very uncommon especially in patient with no immunologic defects and in cases without specific treatment. A 7 years old male patient, without any immunocompromised defect, presented an atypic presentation of the cat scratch disease. The patient came to the hospital in two opportunities in a status epilepticus, in both cases the diagnosis was encephalitis by Bartonella henselae and the evolution with treatment was monitored with PCR (polymerase chain reaction) in cerebrospinal fluid and blood, as well as IFI (IgM, IgG) serology (indirect immunofluorescence). The patient had a favorable clinical and laboratory evolution for 6 months showing no recurrence of the disease. / This work has been partially supported by the Programa Nacional de Innovacion para la Competitividad y Productividad ´ (Innovate Per ´ u), under the contract 116-PNICP-PIAP-2015.